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CAPE CO® o ,, , � �,
INSULATION � �?! �
E1 6
NBER GLASS SEAMLESS SPRATEOAM SUSPENDED
BATTS GUTTERS INSULATION CNLINGS Q�V B 1 �
1-80.0-696-6611 roll v
Town of Barnstable
Regulatory Services
Building Division
200 Main St
Hyannis, MA 02601
Date:
Dear Building Inspector
Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed&
completed the insulation and weatherization work at the property listed below. Cape Cod
Insulation did this in accordance to the specifications listed on the building permit
application. All work has been inspected by a certified Building Performance Institute
(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements.
Property Owner L Property Address Village
4 �Uvrl teA LuAe Cen wul
Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted
Ceilings ( ) ( X ) OS-1 ( ) ( )
CtICJ-7js
Slopes ( ) ( ) ) ( ) )
Floors ( ) ( ) ( ) ( ) ( )
Walls ( ) ( ) ( ) ( ) ( )
Sincerely
He y E Cas y Jr, President
C e Cod I ulation, Inc.
' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
MapVI Par/el Applicatio 7 -Z 6�f
Health Division Date Issued
Conservation Division Application FeO
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _Preservation/Hyannis
Project Street Addresss, 1 a W' t�_----,
Village
Owner 1DWA W 14 Address
Telephone
Permit Request ��G (a,�iol, w-e GzA4uk-+ 6 of
y 1 �v R� 6 -�u o a c ace: "l u• R� ��
20 a 6�cG tee,.
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type ''
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing new Half: existing nevw
Number of Bedrooms: existing _new ; a
Total Room Count (not including bath,:)): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other =} Ln
00
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/co I stove: O YesJ No
ry
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes 34o If yes, site plan review#
Current Use Proposed Use
APPLICANT INFORMATION
fJ
A
-_- _. - DER OR HOMEOWNER) _
Name 5 Telephone Number
Address t U �K VG�, License # 0O U
D' Home Improvement Contractor# 3sb�
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL PE TAKEN TO
qateKI-1
SIGNATURE DATE l
F:
? , FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO. '
ADDRESS i VILLAGE _
OWNER '
f
DATE OF INSPECTION: — -
k
FOUNDATION
c , -
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING r"
DATE CLOSED OUT
ASSOCIATION PLAN NO. •'-
Massachusetts - I)cl)artment of Public SafetN
Board of Huil-ding Regulations and Stan lards
® Construf-tion Supervisor License
-
Licenr CSC 10098846
_
HENRY CASSIDY '
8 SHED ROW
WEStT 1JARMOUTH, MA 02673
�-�- —� Expiration: 1 1 11 1/201 3
( oinmissi ncr Trit: 7620
Office of Consumer Affairs and Business Regulation
- 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: '153567
Type: Private Corporation
Expiration: 12/15/7b14 Tr# 233831
CAPE COD INSULATION, INC
HENRY CASSIDY
18 REARDON CIRCLE
SO. YARMOUTH, MA 02664
Update Address and return card. Mark reason for change.
(� Address u Renewal Employment I I Lost Card
sca i <i 20M.( i i
_:a4\ Office of Consumer Affairs& Business Regulation License or registration valid for individul use only
h , tIfOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
1 egistration: 153567 Type: Office of Consumer Affairs and Business Regulation
:expiration: 1211`5/2014 Private Corporation 10 Park Plaza-.Suite 5170
Boston,MA 02116
CAPE COD INSULATION,`I. .
HENRY CASSIDY
18 REARDON CIRCLE
SO.YARMOUTH, MA 02664 --�' — — ----- ----
Undersecretary Atval' witho t nat re
f
The Commonwealth of Massachusetts Print Form
ITS ,.� Department of Industrial Accidents
Office of Investigations
IT' I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Naine (Business/Organization/Individual): la o
pt
Address:_ d 0061,&
city/state/zip: M, MA' Phone #: r?D0- '17a-j - I Z
Are you an employer? Check t e appropriate box:
Type of project(required):
I. I am a employer with 20 4• ❑ .I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprieto'r or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g• ❑ Demolition
working for n:e in any capacity. employees and have workers'
insurance.$ 9. ❑ Building addition
comp.(No workers' comp. insurance P•
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 1 LEI Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12•❑ Roof re a•rs
insurance required.] .t c. 152, §1(4), and we have no
e� ey� hD
employees. [No workers' 1.3.� Other
comp. insurance required.]
'Any applicant that checks box 81 must also fill out the section below showing their workers'compensation policy information.
I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
l 'ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
omployees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.InsuranceCompanyName: "lf,,, awh - IN.-Mvao 6 r?j
Policy #or Self-ins. Lie. #: WGA OD ��
( - 1 Expiration Date:
.lob Site Address: � ) s U!/wt'VL E44 A., City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of
tide up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the D1A for insurance coverage verification.
1 do hereby certif ytifler the pains penalties of erjury that the information provided above is true and correct.
Silture: / 2 Date:
Phone#: d/ -7 1
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
IVv. IUl1 I . 1
` y-y Cllerltl/': 4507
CERTIFICATE OF LiiABILITY INSURANCE
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ACCORDANCE WITH THE POLICY' PROVIUIONtr.
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t�'It)tl 20-10ACORD CORP QNAVION,All rtylII laacaratl.
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OWNER AUTHORIZATION F
ORM
(Owner's Name) ,
owner of the property located at
(Property Address)
(Property Address) '
hereby authorize _ �,:,O(ry
(Subcontra r) '
an authorized subcontractor'for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my.property..
Owner's Signature
Date
YOU WISH TO OPEN A BUSINESS?
For Your-Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS
NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, I" FL., 367 Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law.
' E r Fill in please: Date:
APPLICANT'S NAME:
itxw r`' YOUR HOME ADDRESS: Gcav'?ht ��.�-r s.►,
/�qA E a�l 6.j
BUSINESS TELEPHONE # S HOME TELEPHONE #: may
NAME OF CORPORATION 'S
NAME OF NEW-BUSINESS , �K1' � 's '� "€ �f-►fir.. TYPE OF BUSINESS`'���E bV1�r
IS'.THIS'A HOME OCCUPA IV TIO , YES NO
ADDRESS OF BUSINESSra3 . _MA �,
P/PARCEL.NUMBER (Assessing)
When starting a rnew business there are several .things you must do to be in compliance with the rules and regulations`of the Town of
Barnstable. This form is to assist you in obtainirig the information you may need.' You MUST.GO TO 200 Main St. (corner of Yarmouth Rd.
& Main Street)to make sure you'have the appropriate permits and licenses required to legally operate your business in town
1. BUILDING q'dualoe_en
NER'S OFFICE'
This indi i r e of ny permit requirements that pertain to this type of business.
ite igrDathre** MUST COMPLY WITH HOME
)MMENTS/T� 0 A��0 0 0 1 V-C
RULES AND REGULATIONS. FAILURE TO
a COMPLY MAY RESULT IN FINES:
S.`
2. BOARD OF EALTH
This individual has been informed of the permit requirements that pertain to this type of business.
Authorize
d Signature**
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of.business.
Authorized Signature**
COMMENTS:
y
Town of Barnstable
IME Regulatory Services
P Thomas F.Geiler,Director
Building Division
MASS.
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Fee: '434 d-o
Permit#: o
HOME OCCUPATION REGISTRATION
Date:
Name• c o� i Phone# Sa 6 (� 0
Address: 3 I So u c"1k EA S t- L N, k
-- 1?4
. 1 � Village: .� i,�C�
Name of Business: w t jS ` " a--4 l C_`
Type of Business: -R EC �� Oq t l + { fZU►.e 11� Map/I ot: -
INTENT: It is the intent of this section to allow die residents of the Tomi of Barnstable to operate a home occupation
Ivzthin single family dwellings,subject to the provisions of Section 4-1.4 of die Zoning ordinance,provided that the activity
shall not be discernible from outside die dwelling: there shall be no increase in noise or odor;no visual alteration to the
premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;
and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be pernnitted as of night subject to,the
following conditions:
• The activity is carried on by the permanent resident of a single fannily residential dwelling unit,located writhin
that dwellirhg unit. i
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling vv ihich are not customary in residential buildings,and there is
no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,
odors,electrical disturbance,heat,glare,humidity or other objectionable effects:
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,uiexcess of
normal household quantities.
• Any need for parking generated by such use shall be met on the same_ lot containing the Customary Home .
Occupation,and not wzdhin the required front yard.
• There is no exterior storage or display of materials or equipment.
• There are no commercial vehicles related to the Customary Home Occupation,.other than one win or one
pick-up truck not to exceed one.ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on die same lot containing tie Customary Home Occupation:
• No sign sliall.be displayed indicating the Customary Home Occupation..
• If die Customary Home Occupation is listed or advertised as a business,die street address shall not be
included:
• No person shall be employed un the Customary Home Occupations wlno is not a permanent resident of the
dwelling unit.
I,the,undersigned,have read and agree v itl the above restrictions for my home occupation I am registering.
Applicant:
Date:
Homeoc.doc Rev.01/3/08